What remedies cannot be taken before surgery

For surgery to proceed with less risk and for recovery to be faster, it is important to follow the doctor's instructions regarding the continuation of certain treatments, since in some cases, it is necessary to suspend the use of certain medications, especially those that facilitate the risk of bleeding or bring some type of hormonal decompensation, such as acetylsalicylic acid, clopidogrel, anticoagulants, non-steroidal anti-inflammatory drugs or some diabetes medicines, for example.

Many medications must also be evaluated on a case-by-case basis, such as contraceptives and antidepressants, which are suspended in people at greater risk of having a reaction. Other drugs, such as antihypertensive drugs, antibiotics and chronic steroids, need to be maintained and taken even on the day of surgery, as their interruption can cause hypertensive peaks or hormonal decompensation during surgery.

Thus, it is important that, before surgery, a list of the medicines that the person is taking is made, to be delivered to the doctor, including homeopathic or others that do not seem important, in order to avoid any risk at the moment of the surgical procedure.

In addition, other precautions must be adopted, such as quitting smoking, avoiding alcoholic beverages and maintaining a balanced diet, especially in the days before surgery and throughout the postoperative period. See more details about the care that should be taken before and after surgery.

1. Antiplatelet agents

Antiplatelet drugs, such as acetylsalicylic acid, clopidogrel, ticagrelor, cilostazol and ticlopidine, popularly known as "blood thinning" drugs, should not be used before surgery, and should be discontinued 7 to 10 days before, or as required doctor's indication. Platelet antiaggregants that have a reversible action, may be suspended according to their half-life, which means suspending the medication about 72 hours before surgery.

2. Anticoagulants

People who use coumarinic anticoagulants, such as Marevan or Coumadin, can only undergo surgery after their suspension, requiring coagulation levels, assessed by the INR exam, to be within the normal range.

People who use the new anticoagulants, such as rivaroxaban, apixaban and dabigatran, may not need to suspend the medication for minor surgery, such as dermatological, dental, endoscopy and cataract surgery. However, if they are more complex surgeries, these medications can be suspended for a period that can vary between about 36 hours and 4 days, according to the size of the surgery and the person's health conditions.

After the suspension of anticoagulants, the doctor may indicate the use of injectable heparin, so that in the period that the person is without medication, there is also no increased risk of complications, such as thrombosis and stroke, for example. Understand what the heparin indications are and how to use them.

3. Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs should not be used before surgery, as they also interfere with the blood's clotting ability and can only be used up to a maximum of 3 days before the procedure.

4. Hormonal therapies

Contraceptives do not need to be stopped before minor surgery and in women who are at low risk of having some type of thrombosis. However, women at increased risk, such as those who have a previous or family history of thrombosis, for example, should stop using the medication about 6 weeks before and, during this period, another type of contraceptive method should be used.

Hormone replacement therapy with tamoxifen or raloxifene, should be withdrawn in all women, 4 weeks before the surgical procedure, as their hormone levels are higher, therefore causing a greater risk of thrombosis.

5. Remedies for diabetes

Tablet medicines for diabetes of various types, such as glimepiride, gliclazide, liraglutide and acarbose, for example, must be discontinued the day before surgery. Metformin, on the other hand, must be discontinued 48 hours before surgery, as it poses a risk of triggering an acidosis in the blood during surgery. In the period after drug withdrawal, it is important that blood glucose is monitored and, in cases of increased blood glucose, insulin should be used.

In cases where the person uses insulin, it should be continued, except for long-term insulins, such as glargine and NPH, in which the doctor may reduce the dose in half or 1/3, so that the risk is reduced hypoglycemia during surgery.

6. Cholesterol medications

Cholesterol drugs should be discontinued 1 day before surgery, and only statins, such as simvastatin, pravastatin or atorvastatin, for example, can be maintained, as they do not cause any risks during the procedure.

7. Remedies for rheumatic diseases

Medicines such as allopurinol or colchicine, indicated for diseases such as gout, for example, must be suspended on the morning of surgery.

As for the drugs used to treat diseases such as osteoporosis or rheumatoid arthritis, most of them must be suspended the day before the surgery, however, in some cases, it may be necessary to suspend the treatment about a week before the surgery, in remedies such sulfasalazine and penicillamine.

8. Phytotherapics

Herbal medicines are considered, by the population in general, safer in relation to allopathic remedies, and their use is very frequent, as well as the omission of their use before the doctor. However, they are drugs that can also cause side effects, and many of them lack scientific proof of effectiveness, and can seriously interfere with surgery, so they should always be suspended.

Herbal medicines like Ginkgo biloba, Ginseng, Arnica, Valeriana, Kava-kava or St. John's wort or garlic tea, for example, can cause side effects during surgery, such as increasing the risk of bleeding, leading to cardiovascular problems or even increasing the sedative effect of anesthetics, therefore, depending on the herbal medicine in question, they should be suspended between 24 hours to 7 days before the procedure.

9. Diuretics

Diuretics should be discontinued whenever the surgery involves risk or when blood loss is predicted, as these drugs can alter the kidneys' ability to concentrate urine, which may impair responses to hypovolemia.

In addition, caffeine-rich drinks and supplements such as coffee, green tea and black tea should also be avoided in the week before surgery.

After the surgical procedure, the treatment may be resumed, according to the medical indication, depending on the recovery and reduction of the risks of side effects. Also know what are the main precautions to take to recover faster from surgery.

Remedies that can be maintained

The medications that must be kept, even on the day of surgery and during fasting, are:

• Antihypertensives and antiarrhythmics, such as carvedilol, losartan, enalapril or amiodarone, for example; Chronic steroids, such as prednisone or prednisolone, for example; Asthma remedies, such as salbutamol, salmeterol or fluticasone, for example; Treatment of thyroid diseases, with levothyroxine, propylthiouracil or methimazole, for example; Remedies for gastritis and reflux, such as omeprazole, pantoprazole, ranitidine and domperidone, for example; Treatment for infections, with antibiotics, cannot be stopped;

In addition, some medications can be maintained with caution, such as anxiolytics, antidepressants and anticonvulsants, because although they are not contraindicated before surgery, their use should be discussed with the surgeon and anesthetist, as they can interfere with some types anesthesia and, in some cases, increase the risk of complications.